document.write('<!--LP_FORM_START-->');
document.write('			<form  method="post" name="sfm-form" id="sfm-form" class="h-adr" action="//hikari-cpn.com/flets/east/area/confirm.html">');
document.write('				<table>');
document.write('					<tbody>');
document.write('						<tr class="required-input">');
document.write('							<th>郵便番号 <span class="required">必須</span></th>');
document.write('							<td><input type="text" inputmode="numeric" id="postcode" name="postcode_s" size="7" maxlength="7" placeholder="例）1234567" value=""></td>');
document.write('						</tr>');
document.write('						<tr class="required-input">');
document.write('							<th>お名前 <span class="required">必須</span></th>');
document.write('							<td><input class="text" type="text" name="name_s" id="name" size="30" placeholder="例）引越 太郎"  value=""/></td>');
document.write('						</tr>');
document.write('						<tr class="required-input">');
document.write('							<th>電話番号 <span class="required">必須</span></th>');
document.write('							<td><input type="tel" name="tel_s" id="tel" placeholder="例）09012345678" value="" /></td>');
document.write('						</tr>');
document.write('						<tr class="required-input">');
document.write('							<th>メールアドレス <span class="required">必須</span></th>');
document.write('							<td><input type="text" name="mail_s" id="email" class="half-width" placeholder="例）taro@hikari-cpn.com"  value=""/></td>');
document.write('						</tr>');
document.write('					</tbody>');
document.write('				</table>');
document.write('');
document.write('				<!-- PC / スマホアクセスを判別（メール件名振り分け） -->');
document.write('				<input type="hidden" name="subject" value="【光キャンペーン.com_フレッツ光・東日本_日中_pc】提供エリアのお問い合わせフォーム" />');
document.write('				<!-- 注文番号 -->');
document.write('				<input type="hidden" name="orderid" id="orderid" value="20240501102518" />');
document.write('				<input type="hidden" name="action" value="conf" />');
document.write('				<div class="text-center">');
document.write('					<input type="submit" name="submit" id="btn_areaform_1" class="submit button primary" onclick="window.onbeforeunload=null" value="入力内容を確認">');
document.write('				</div>');
document.write('			</form>');
document.write('			');
document.write('<script>');
document.write('var lpQuery = location.search;');
document.write('var element = document.forms[0]; ');
document.write('element.action = element.getAttribute(\'action\')+lpQuery;');
document.write('</script>');